Public Policy Club, IIM Lucknow

Please find below the winning entry from Policyमंच'19, from Abhinav Jain PGP350002

Modicare: Ayushman Bharat; Discuss accessibility, viability and societal relevance

Ayushman Bharat or Pradhan Mantri Jan Arogya Abhiyaan or National Health Protection Scheme or Modicare is the world’s largest government-funded health programme meant only for the poor and economically –deprived people. The beneficiaries are identified based on the Socio Economic Caste Census (SECC), 2011 in both rural and urban areas. It is expected to cover up to 10 crore economically deprived families i.e. up to 50 crore Indian citizens.
Two dimensions of Ayushman Bharat Scheme
Firstly, the scheme aims to roll out comprehensive primary health care with Health and Wellness Centers (HWCs), which has been lacking in the country.
Until now, our country’s primary health care has focused on reproductive, maternal health, newborn and child health as well as controlling priority communicable diseases. But this covers only 15% of our needs. There is a huge unmet need for primary healthcare, namely, care for non-communicable diseases, mental health, care of aged, palliative health care and basic eye care. The National Health Protection scheme will help the country to move towards universal healthcare and equitable access to healthcare which is one of the UN Sustainable Goals (SDG).
However, the NHPS is unlikely to fix the broken public health system in the country. The issue at hand remains the limited and uneven distribution of human resources at various levels of health services, with just around 40 % of health worker posts lying vacant in few states. Most primary health care centers suffer from shortage of doctors and even district hospitals are without specialists. This will force the patients to go to private hospitals. Thus, it looks like NHPS will benefit private parties more than government health services.
The Second dimension of Ayushman Bharat is that, it aims to provide free insurance coverage of up to Rs 5 lakh per family per year at any government or even empaneled private hospitals all over India for secondary and tertiary medical care facilities. This mission enables increased access to in-patient health care for the poor and lower middle class. This will result in the reduction of Out of Pocket expenditure by the citizens which currently makes up to 62% of the total health care costs.
But clarity is needed on what services will be provided by government health facilities and for which conditions patients will have to use private parties and what mechanisms are being thought of. There is a need for uniform pricing systems for various health interventions, including diagnostics and medicines, and making them transparent by displaying them in hospital premises.
Financial Viability
The NHPS operates around the insurance principle of ‘risk pooling’. When a large number of people subscribe to an insurance scheme, only a small fraction of them will be hospitalized in any given year. In a tax-funded system or a large insurance programme, there is a large risk pool wherein the healthy cross-subsidize the sick at any given time. The NHPS will be financially viable, despite a high coverage offered to the few who fall sick in any year, because the rest in the large pool do not need it that year.

Acceptability by States
The Centre finances 60 per cent of the costs incurred on the target beneficiaries in the states. It is similar to the Rashtriya Swasthya Bima Yojana (RSBY) in that respect but with the sum assured now a whopping Rs 5 lakhs as compared with the RSBY’s Rs 30,000: the coverage has enabled expansion to include tertiary care. But some state governments are unhappy with the scheme, as the union government is perceived as “stealing the credit” from the concerned state government. There is some justification in these concerns. For one, the state governments are not only funding 40 per cent of the scheme (barring the north eastern and hill states that get 90 per cent funding from the Centre) and bearing the cost and responsibility of its implementation, they are also covering double the number of beneficiaries funded by the central government. For another, furthering the perception that the NHPS is a central government initiative and taking all the credit is like putting salt on a wound as the idea for Ayushman Bharat itself originated in united Andhra Pradesh and was further improved and worked upon by other state governments.
The question of who gets the credit may not sound so important in the larger scheme of things. But for political parties going for elections, when the people’s perception is critical — these are sensitive issues.

Challenges and Way forward
Going by the current spatial distribution of the private health sector in India, its growth in response to the Ayushman Bharat–NHPS is likely to be patchy and concentrated in geographical pockets. The unevenness and urban bias in India’s health infrastructure restrict all three dimensions of access to healthcare - physical accessibility, financial affordability and acceptability of health services. While health insurance schemes such as the Rashtriya Swasthya Bima Yojana (RSBY) may have countered some of the inequities operational within and across the households, they falter in the face of geographical inequities. The pattern is likely to be repeated under the Ayushman Bharat–NHPS.
Allocations for Ayushman Bharat Scheme are inadequate, and if the failures of RSBY are any indication, the NHPS is likely to result in over-treatment or unnecessary surgeries. Hence, if the scheme is used (overused/misused), premium rates are bound to increase. To prevent this well-designed standardized protocols and guidelines for admission are needed.
Success of the scheme will depend upon focusing on health and not merely sickness. Reducing disease burden through robust primary care, focus on allied determinants of health, quality outdoor and indoor services in public hospitals and incorporation of indigenous school of medicine and technology will all help in checking farcical and wasteful expenditure. Instead of shrinking its role in health-care provision, participation of government system has to be increased progressively. More allocation of funds and its innovative application to recruit and retain the specialists in government setup is the need of time.

Public Policy Club marked the beginning of the academic year 2019-2020 with the launch of "Policyमंच 2019" - online quiz and article submission competition for the students of IIM Lucknow.

We congratulate the following winners of Policyमंच 2019 who battled hard among 97 participants and emerged victorious!

1st Place : Abhinav Jain PGP35002
2nd Place : Gaurav Kunal Jaiswal PGP34363
3rd Place : Shrey Toshniwal PGP35189

Shoutout to everyone for participating and making this event a huge success!

The event "Meet the Leader 2019" conducted by PPC of IIM Lucknow gave the students an opportunity to interact with the Dr. Urvashi Sahni, founder curator Global Shapers Hub Lucknow, and her group of extremely enthusiastic Global Shapers.

In the speaker session, Dr. Sahni enlightened the audience on "Democratic citizenship education" and it's contextual relevance in today's society. This was followed by a presentation round with the following winners.

First position
1Jeevanantham N (PGP34018)
2. Mohammad Harris A (ABM 15018)

Runners-up
1. Pranav Soni (PGP34077)
2. Sneha .(PGP34093)

We congratulate the winners and thank the Lucknow Global Shapers Hub for the wonderful evening.

To know more about Lucknow Global Shapers Hub, Please visit https://www.globalshapers.org/hubs/lucknow-hub

Greetings from Public Policy Club!

We are glad to announce the official launch of "Meet the Leader" program - in association with Global Shapers Lucknow Hub.
The theme of the event is "Global Citizenship Education"

Global Shapers Lucknow Hub is a part of the larger and universal Global Shapers Community, World Economic Forum and is extensively anchored and focused on transforming education for women and youth empowerment, policy, governance, leadership, and entrepreneurship.
To know more about the hub, please visit https://www.globalshapers.org/hubs/lucknow-hub

As a part of our first speaker session, we would like to welcome Dr. Urvashi Sahni, the founding curator of Global Shapers Community Lucknow Hub. Dr. Sahni is a social entrepreneur, women rights activist and educationist. She is also the recipient of the India Social Entrepreneur of the Year award by the Schwab-Jubilant Bhartiya Foundation for her work in educating India’s most disadvantaged girls. She has been recognized by the Obama Foundation Global Girls Alliance and the Clinton Foundation as a Change Maker. To know more about her, please visit http://www.studyhallfoundation.org/urvashi-sahni.php

Please watch this space for further updates regarding the event.

5-6 January, 2019 by CCS and PPC, IIM Lucknow

Here are few snapshots of “ABHIMAT”, Public Policy Club, IIM Lucknow’s Newsletter Vol.1